VBAC Induction ?'s - Stillbirth

Hello ladies, I am 41 + 1 today and my midwife has suggested that I see her OB for induction. I have no effacement, no dilation and the baby has not completely dropped so she feels that it is in my best interest to have a hospital birth. I have been taking orally and inserting the prime rose, walking, having lots of sex and have taken castor oil and nothing has helped. I am not comfortable with being medically induced but would rather try that then have a repeat cesarean. Can anyone tell me if they will use pitocin for the induction or is there something that is a little bit more natural and less evasive. A friend of mine told me that she has heard of a pill that can be inserted next to the cervix that will help enduce me, but I can't find anything on the net. I still want to stay far away from an epidural but am afraid that the pitocin will make the contractions too powerful and will limit me to my bed.

Thank you so much for any info you can share, I'm frustrated and scared and want to make sure that I make all the right decisions for myself and my son.

Amie

My son Evan was still born by cesarean section on 6-7-10. OB said that the cord had clotted and was in knots. It has been a very hard time for me as I am second guessing all the decisions I made throughout the pregnancy. I am wondering if I shouldn't of just had a cesarean section at 39 weeks like some doctors had suggested. I know that I am not to blame and no one could of predicted what happened but I can't help but to punish myself.

Thank you everyone for all the encouragement you gave me during the last couple of weeks during my pregnancy. My husband and I are hopefull for the future and to getting pregnant again.

Replies to This Discussion

First, I would find out what your Bishop score is. You can ask your midwife or the OB. If it's 4 or less, the chances of a chemical induction being successful is slim, making another c-section almost certain. My guess is that if your labor isn't starting with all of the things you have tried, it's just not time.

I'm surprised that your midwife is suggesting a chemical induction since you are trying for a VBAC. From what I understand the incidence of uterine rupture is higher with a VBAC if a chemical induction is used.

I think the pill your friend was referring to is called Cytotec. It would be administered at the hospital, it's not something you would do at home.

The main question is this~Are you and your baby doing ok right now? If so, then there should be no harm in waiting. If your baby is showing signs distress, then it is time to act.

Of course, your midwife has been with you and knows your medical history, so she will know more about your situation than we do and is probably acting accordingly. But if you feel like your birth is about to go down a path that you don't want it to, keep in mind that you have choices and that asking for a second opinion is never a bad thing to do!

Cervadil is another pill inserted next to the cervix, it doesn't induce contractions like pitocin does, it instead softens the cervix which can release prostaglandins which will in turn help get labor started. Often if your Bishop score is favorable, just the cervadil can kick start things.
The main "risk" of VBAC is uterine rupture (at least to the doctors, for most mothers, it's the risk of repeat section). And chemical inductions tend to increase both that risk and the risk of a repeat C-section. But a gentle pitocin induction shouldn't raise your risk of uterine rupture (what doctor's are worried about), but emphasis on gentle. However, a cytotec induction significantly raises your risk of rupture, in fact, I believe widespread use of cytotec on VBAC mom's in the 90's was what caused ACOG and most hospitals to eliminate the VBAC option. It's other name is Misoprostel, or Miso.
See if your midwife is willing to give you a few more days, at least until you are clinically overdue, which is 42 wks. Tell her you're willing to do all the NST's she wants! You never know what another 24 hours will do.

I would NOT suggest cervadil or cytotec (ESPECIALLY) for a VBAC induction. These prostaglandins have a higher rupture rate than just pitocin. I also was overdue with my VBAC attempt (41 wks 3 days) and induced with pitocin. But my body wasnt ready, and I had another csection for failure to progress. If you and baby are fine, refuse intervention. With my 3rd child (and 2nd attempt at VBAC), I choose a birth center. I was 40 wks 3 days and had a pregnancy accupunture treatment to start labor, and an hour labor I went into labor naturally. PLEASE consider this before any hospital inducing/augmenting. I had a two day labor this time, but it was wonderful compared to the pitocin induction. Unfortunately though, I didnt get my VBAC this time either. Baby had a short cord and it was wrapped around his neck 3 times and he couldn't engage and was breech. So once I transferred I was like 5 cm and feet were presenting. Even though it ended in surgery, it was my best labor yet. Good luck and keep us posted!

DO NOT USE CYTOTEC! The hospital based midwives I was originally seeing said the DO NOT induce any VBAC candidates. I switched to a homebirth midwife team at 32 weeks.

Talk to your midwife about Castor Oil, it will only be effective if your cervix is READY. Have you midwife check your cervix to see if it has started to soften up. She can "strip your membranes" to try to stimulate your body to produce prostaglandins to soften and thin the cervix. This may take more than one try.

You may not be "41 weeks" exactly. And 40 is only an average. All of my babies were born at 41.5 weeks; dates based on ultrasound measurements in early pregnancy. I was 44 weeks according to the calendar. The first 2 kids were c-sections, the 3rd was a HBA2C, born in a birthing pool, 2 separate sessions of membrane stripping by the midwife about 4 days apart, and when the cervix began to open a tad and thin on the second session, the next day we (the birthing team) put into motion a plan to use Castor Oil, 3 doses about 2 hours apart. Started contractions within 20 minutes of taking the first dose, and proceeded to have a relatively quick labor, the second and third doses were to keep the momentum going. I chalk this success with induction ONLY to waiting for a favorable cervix. I had ultrasounds the last 2 days of the pregnancy to check on baby/fluid levels and all was fine for him to stay put, and take it one day at a time waiting for the cervix to cooperate. My midwife did not encourage using castor oil on the day that she first checked my cervix (41 weeks) as it was still hard and tightly closed.

Thank you so much for all of the info. I honestly feel like he is not ready and all of my castor oil milkshakes and walking are not helping because of that fact. For 35 weeks of this pregnancy I was due May 28 but when I was transfering care to the midwife she required an ultrasound and NST, the baby measured larger so they changed my due date to the 17th. I'm thinking that the 28th is a more accurate EDD so I am going to try to push to keep this as my date and hopefully the OB will agree. I know it's my decision and I can refuse any interventions that they recommend but I am also nervous that I make the right decision. I thank you again for the support!

I was scared into inducing b/c of a "large" baby and would never do that again. Personally, unless the baby is showing signs of distress or you have other medical indications that cause concern, I would wait it out. If it is just a matter of the baby's size or a due date, then what is the rush? From what I've read, most women can give birth to 10 and 11 lb babies vaginally just fine - especially if they aren't induced. Try to get all the facts about WHY they are wanting to induce already.

Btw, in my Bradley classes, they told us that MOST women go to 41+1 these days anyway. So, you are right on schedule and they shouldn't be so worried about getting baby out of there. Again, unless there are medical indications that are making them nervous about your health or the baby, why not wait? I know I wish I had waited...

I was always late with my pregnancies as well, but I did shows signs of progressing (baby dropping, dilating, etc.) I delivered both my boys at 42 weeks. I chose to go to the hospital and get induced with both for a number of reasons (previously uneducated about my options, in pain and tired of being pregnant at 42 weeks, etc.) I delivered the first with an epidural because I didn't know any better and that is what "everyone" does. I hated it. So with the second, I got induced with pitocin and I walked and sat and moved around and worked thru my labor. I was able to deliver without any pain meds and it was absolutely AMAZING! You must have someone there to help you thru the hard times, someone who knows you want to go as natural as possible. My doula was with me and keep me strong in my decisions because the doctors all tried to get me to have an epidural...just because. THe contractions are stronger with Pit but you just have to find the right position that makes them tolerable.
There is a "pill" they can insert next to the cervix call Cervidil that is suppost to start thinning the cervix. If you get inducted at the hospital, they will use Pitocin. What really triggered my labor to start was when they broke my bag of waters. If your midwife is comfortable with that, you could have your bag broke and see if things progress on their own. If you don't see ANY progression in 12 hrs, I would head to the hospital and try Pit.
You can also have an ultrasound and check the weight of the baby now. If your fluid still looks good and your baby isn't huge, you can always wait another week and see if you progress. That may be the best option if you truely want a natural birth.
Best of luck and you can deliver without an epidural and I would highly recommend it.

I have done so much research and I am a complete fan of homebirth now. I wish I would have known more back then. When I get pregnant again, I will try for a homebirth even though my hubby is a bit freaked out by the idea.

The downfall about Cytotec is that it has no FDA approval for use in pregnant women. It was FDA approved to prevent ulcers, and without proper research in use of pregnant women it can cause awful side effects. There is not even a manufacturer's recommended dose for labor induction with Cytotec, which means ob/gyns chose their own dosage regimen. As was stated previously this drug can cause uterine ruptures. Forty-nine studies yielded a total of 5,439 women who were given Cytotec to induce labor. 25 women had ruptured uteri, 16 babies died, 2 women had such profuse bleeding that they had emergency hysterectomies, and 2 women died. Ruptured uteri were especially likely to happen to women who had had previous uterine surgery, such as a c-section. I am not providing these facts to scare you in anyway just to make you and other aware of the dangers of such intervention. (Taken from Ina May's Guide To Childbirth)

My mother was over 44 weeks when she had my sister (he first birth), she was 43 weeks when she gave birth to me and 41 weeks when she had my younger sister. So women just carry longer and it's completely natural. I pray you get the VBAC you desire. My well wishes to you and your son.

I too was a VBAC Mom. With my 1st son my Midwife worked in an OB practice that would not induce VBAC Moms and would not let them go past 40 weeks: you either went into labor before 40 weeks or they scheduled you for a c-sec at 40 weeks 1 day. Other doctors will induce at 40 weeks. Some doctors will not induce at all but will let you go to 42 weeks...point is the feelings/practices with inducing and "overdue" dates w/VBAC Mom's vary widely from doctor to doctor.

Research shows that inducing a VBAC Mom with drugs does increase the chances for a uterine rupture. The chance is still small but it is increased esp with prostaglandins (including the pill your friend told you about) and Cytotec. Research also shows that being over 41 weeks increases your chances of a rupture, but again the increase is very small. And the increase in risk w/induction is greater than the increase in risk from being "overdue". Pitocin is the drug of choice to induce VBAC mom's. While they may recommend prostaglandins I would not allow them to use these.

Cytotec is def not OK to use when inducing a VBAC Mom, or any other Mom for that matter. Not only is is NOT FDA approved for that use the makers of it voluntarily sent warning letters to OB's across the country warning them NOT to use it in pregnant women because of all the side effects. Many dead babies and Mom's either dying or having to have uterus removed due to massive ruptures. This happened in VBAC patients and in patients with no history of c-sec, many were first time Mom's.

Induction itself is a slippery slope to many, many medical interventions including c-sec. It keeps your body from going through the natural chemical process that helps you handle the pain. Plus the intensity and duration of the contractions is above what you would normally have. My analogy: instead of slowly accelerating in a sedan so you can gradually adjust, you go from 0 to 60 in seconds like in a race car :) You will have an IV a Blood Pressure Cuff and continuous fetal monitoring. Good chance they will want to break your water to do internal monitoring, esp being a VBAC. These are all things you could resist w/out being induced but are necessary if you are. This will make you even more uncomfortable and reduce your mobility, further reducing your ability to deal with the pain. Then comes the increased chance you will request an epidural, as you mentioned, now comes the catheter and confinement to bed. And now if you don't end up w/a c-sec you will be in a very luck but small minority.

IMO, induction, VBAC or not, should only be chosen when tests, like a NST, show that the baby would be better off being born. Only that is an indication that nature is not doing what it should. It should have nothing to do with numbers on a calendar. Calendars are man made and your body & baby operate in nature not within made made constructs of time. With a VBAC this is esp important b/c your chances of successful vaginal delivery are highest when you go into labor on your own and lowest when you are induced.

As far as dilation and the baby dropping...that is NOT an indication of when labor will start. Some women are at a 0 then go into labor a few hours later. Other women can start dilating and be at a 3 for weeks before labor starts. And for most 2nd and subsequent pregnancies the baby doesn't usually drop until labor starts so again NOT a good indicator of going into labor. Even if the baby does drop that doesn't mean anything could be like that for weeks with no labor. I was at 90% effaced, 3 cm dilated and my baby dropped--for 4 weeks before I actually went into labor. I am shocked and a little disappointed that your Midwife would consider lack of dilation or baby dropping as a good reason to induce.

Other ways to kick start labor naturally? Nipple Stimulation. This link explains it. They say do one breast at a time. I recommend doing both. http://www.givingbirthnaturally.com/nipple-stimulation-to-induce-la...
My Midwife gave me Labor Start. It contains herbs that induce cervical ripening and contractions. Ask you Midwife about it. Acupuncture and/or acupressure. But remember--nothing will make you go into labor if its not time. Except Pitocin. And even then if its not time the induction will most likely fail resulting in a c-sec.

If it was me I would insist on NST to monitor the baby and only consent to an induction if the NST indicated the need. 43 weeks seems to be the high end of OK when it comes to pregnancy lengths. Maybe your DD is off or maybe your baby is a slow cooker :) I would (and did) stimulate my nipples and try the other herbs in addition to acupuncture.

Well the OB appt went well, I had an NST and an ultrasound. The fluid levels still look good and the heartbeat was beautiful. She has given me until June 10 to go into labor if not a repeat cesarean is scheduled. I have been stretching, lunging, squatting and walking trying to get the baby to drop but I still feel like he may be sitting a little high. I have an appt on Thursday with the midwife and hopefully I will have some dilation by that point. Thank you for all of your encouragement, it has really helped me.

Oh, Amie, I am so sorry for the loss of your precious son. I am glad that you know you are not to blame, and are not wasting time and energy on second-guessing your decisions. I wish you and your family healing and peace as the days pass, and will pray for all of you, including Evan.